Tombstone cost and longevity: The San Pedro Cemetery Museum in Medellín in Colombia

Background Studies in the West suggest that tombstone cost is associated with longevity. The objective of this observational study was to investigate the association between tombstone cost and longevity in a large cemetery in Latin America. Methods Age at death was obtained from 2,273 consecutive death certificates held at the San Pedro Cemetery Museum in Medellín in Colombia. Subjects died in 2022, 2021, or 2020. Tombs are arranged in galleries in the cemetery and tombstone cost was based on the material from which the tombstone was made, its position in the gallery, and its ornamentation. Analysis of variance was used and the assumption of equal variance was not violated. Results Approximately 77% of tombstones were of low cost, 21% of medium cost, and 2% of high cost. Data from 1,751 subjects were used to investigate differences in longevity according to tombstone cost while adjusting for sex, civil status, violent death, and year of death. Longevity was similar in the low-cost group and medium-cost group: 64.3 years (63.2, 65.3) versus 63.3 years (61.3, 65.3) [estimated mean (95% confidence interval)]. Longevity was lower in the high-cost group: 47.0 years (40.1, 53.9). Conclusions The inverse association between tombstone cost and longevity would suggest that people in Medellín are inclined to spend more on tombstones when commemorating the tragic death of a young person.


Classification according to ornamentation
We visited several stonemasons near the San Pedro Cemetery Museum to determine the costs of the various ornamentations that might be added to a tombstone.Table S3 shows some of the ornamentations used in the present day.Costs varied from as little as COP 12,000 for a flowerpot to COP 150,000 for an engraving.The costs of the ornamentations on a tombstone were summed to create cost categories.The high-cost category included ornamentation to the sum of greater than COP 200,000.The medium-cost category included ornamentation to the sum of COP 101,000-200,000.The low-cost category included ornamentation to the sum of COP 0-100,000.The high-cost category was given a score of three points, the medium-cost category two points, and the low-cost category one point.

Weighting of tombstone characteristics
Tombstone cost was weighted by tombstone characteristics because differences in material had a greater influence on differences in cost than differences in position or differences in ornamentation.Tombstone material was given a weighting of 0.7, tombstone position was given a weighting of 0.1, and tombstone ornamentation was given a weighting of 0.2.

Final classification
Tombstone characteristics were multiplied by the respective weightings and summed to create the final score.For example, consider the tombstone in Figure 1.The tombstone material is cream marble, giving a score of 2 x 0.7 = 1.4.The tombstone position is head height, giving a score of 3 x 0.1 = 0.3.The tombstone has a flower box and an engraving and the price of these ornamentations is greater than COP 200,000, giving a score of 3 x 0.2 = 0.6.The final score is 1.4 + 0.3 + 0.6 = 2.3.Final scores of 2.4-3.0 were used to classify tombstones as high cost.Final scores of 1.7-2.3 were used to classify tombstones as medium cost.Final scores of 1.0-1.6 were used to classify tombstones as low cost.Therefore, the tombstone in Figure 1 is classified as medium cost.

Mobile phone app
Each death certificate held at the San Pedro Cemetery Museum had a code that indicated the location of the tomb in the cemetery.We created a mobile phone app to help us match up death certificates and tombstones.The app was created using Microsoft Power Apps.Table S4 shows the six steps used in collecting the data.Table S4.The six steps used in collecting data on the mobile phone app Screenshot (in Spanish) Step and description Step 1: Tombstone location.Each death certificate had a code that identified the location of the tomb in the cemetery.Here, the user is asked to enter the code.
Step 2: Tombstone material.The user is shown eight examples of tombstone materials and is required to select the corresponding option.
Table S4 (continued).The six steps used in collecting data on the mobile phone app Screenshot (in Spanish) Step and description Step 3. Tombstone position.The user is shown six rows and is required to indicate the position of the tomb in the gallery.
Step 4: Tombstone ornamentation.The user is shown examples of various ornaments that might be added to a tombstone and is required to enter the corresponding quantities.

Table S4 (continued).
The six steps used in collecting data on the mobile phone app Screenshot (in Spanish) Step and description Step 5: Photo of the tombstone.The user must use the app to take a photo of the tombstone.
Step 6: Confirmation.The user is asked if they are sure about their selections and is invited to save their work.The data are stored securely in Microsoft OneDrive so that the investigators can resolve any doubts about tombstone material or tombstone ornamentation.

Figure S1 .
Figure S1.A tombstone in the San Pedro Cemetery Museum in Medellín in Colombia.The material is cream marble.The position of the tomb is head height.The ornamentations include a flower box and an engraving.The tombstone is classified as being of medium cost, as explained in Section 2.5.

Table S1 .
Classification of tombstone cost according to material

Table S1 (
continued).Classification of tombstone cost according to material

Table S1 (
continued).Classification of tombstone cost according to material

Table S2 .
Classification of tombstone cost according to its position in the gallery

Table S3 .
Ornamentations that may be added to a tombstone

Table S3 (
continued).Cost of ornaments added to tombstones